[Role of Comprehensive Geriatric Assessment(CGA)in Elderly Cancer Treatment].

In the treatment of diverse elderly cancer patients, not only cancer progression and general condition but also social factors, comorbidities, and cognitive function have a great influence. Therefore chronological age and performance status(PS) alone, there is a possibility that under treatment that inappropriately lowers the treatment intensity and over treatment that performs the same treatment as young people without considering the risk of chemotherapy may be performed. Comprehensive geriatric assessment(CGA)evaluates individual health conditions such as physical function, comorbidities, cognitive function, psychological status, social support system, and nutritional status of the elderly from various aspects, and selects treatment. The goal is to be useful for treatment support. CGA results should be shared with other members of the medical team to intervene on issues. And it's important to do it over and over again. CGA may help optimize elderly cancer treatments and improve the quality of life of the limited elderly, not just prolonging their lives.

The Japan Geriatrics Society consensus statement "recommendations for older persons to receive the best medical and long-term care during the COVID-19 outbreak-considering the timing of advance care planning implementation".

Since the end of 2019, a life-threatening infectious disease (coronavirus disease 2019: COVID-19) has spread globally, and numerous victims have been reported. In particular, older persons tend to suffer more severely when infected with a novel coronavirus (SARS-CoV-2) and have higher case mortality rates; additionally, outbreaks frequently occur in hospitals and long-term care facilities where most of the residents are older persons. Unfortunately, it has been stated that the COVID-19 pandemic has caused a medical collapse in some countries, resulting in the depletion of medical resources, such as ventilators, and triage based on chronological age. Furthermore, as some COVID-19 cases show a rapid deterioration of clinical symptoms and accordingly, the medical and long-term care staff cannot always confirm the patient's values and wishes in time, we are very concerned as to whether older patients are receiving the medical and long-term care services that they wish for. It was once again recognized that it is vital to implement advance care planning as early as possible before suffering from COVID-19. To this end, in August 2020, the Japan Geriatrics Society announced ethical recommendations for medical and long-term care for older persons and emphasized the importance of conducting advance care planning at earlier stages. Geriatr Gerontol Int 2020; 20: 1112-1119.

Polypharmacy and gait speed in individuals with mild cognitive impairment.

AIM: Polypharmacy has been reported to be associated with poor outcomes, including falls and frailty, in older populations. Past studies have found that slower walking speed is a good predictor of progression to frank dementia in mild cognitive impairment (MCI). Some studies of the general population reported that polypharmacy was associated with slower gait speed; however, it remains to be elucidated whether polypharmacy affects gait speed even in individuals with MCI, who already have some deterioration in gait compared with cognitively preserved individuals. The current study explored the association between the number of medications and gait speed in older adults with MCI who have a Clinical Dementia Rating score of 0.5. METHODS: A total of 128 individuals with MCI were included in the present study. The participants were divided into three groups according to the number of medications they were taking: up to four medications was non-polypharmacy; five to nine medications was polypharmacy; and ≥10 medications was hyperpolypharmacy. The background characteristics were compared by analysis of variance for numerical numbers, and by χ2 analysis for categorical factors. Multiple regression and logistic analysis were applied to investigate the association between gait speed and polypharmacy status or number of medications. RESULTS: Gait speed was significantly negatively associated with hyperpolypharmacy status and the number of medications. Slow gait speed (<1 m/s) was also significantly associated with polypharmacy status and the number of medications. CONCLUSIONS: We found that polypharmacy was associated with slow gait speed in older adults with MCI. Geriatr Gerontol Int 2019; 19: 730-735.

Burden reduction of caregivers for users of care services provided by the public long-term care insurance system in Japan.

We surveyed the care burden of family caregivers, their satisfaction with the services, and whether their care burden was reduced by the introduction of the LTCI care services. We randomly enrolled 3000 of 43,250 residents of Nagoya City aged 65 and over who had been certified as requiring long-term care and who used at least one type of service provided by the public LTCI; 1835 (61.2%) subjects returned the survey. A total of 1015 subjects for whom complete sets of data were available were employed for statistical analysis. Analysis of variance for the continuous variables and χ(2) analysis for that categorical variance were performed. Multiple logistic analysis was performed with the factors with p values of <0.2 in the χ(2) analysis of burden reduction. A total of 68.8% of the caregivers indicated that the care burden was reduced by the introduction of the LTCI care services, and 86.8% of the caregivers were satisfied with the LTCI care services. A lower age of caregivers, a more advanced need classification level, and more satisfaction with the services were independently associated with a reduction of the care burden. In Japanese LTCI, the overall satisfaction of the caregivers appears to be relatively high and is associated with the reduction of the care burden.

Cognitive impairments and functional declines in older adults at high risk for care needs.

AIM: Functional status of those who have very mild cognitive impairment have not been sufficiently investigated. In the current study, we analyzed the characteristics of functional awareness in older adults who had cognitive impairment and were at high risk of requiring support/care (termed as specified elderly at high risk for care needs in the long-term care insurance scheme). METHODS: The answers of a health check, which is provided by the local municipal government for those aged 75 years or older who have not been certified as eligible for care services, were analyzed. The differences of the variables between the two groups regarding yes/no answers to each of three cognition-related questions were analyzed. Then, a multiple logistic analysis was carried out to investigate the association of yes/no answers of the three cognition-related questions and the awareness of functional decline. RESULTS: The participants who had cognitive impairment had greater awareness of functional declines. Multiple logistic regression analysis showed that subjective memory impairment and disorientation were significantly associated with a wider range of awareness of functional decline. CONCLUSIONS: Subjective cognitive impairment was associated with a wide range of awareness of functional decline in older adults at high risk for care need.